ANAD Support Group Leader Application
Please note: this application is a multi-step process.
1) Fill out this application. 2) You will be contacted by an ANAD representative via email after submitting your application with three documents for you to review, sign, fill out and return to ANAD: Support Groups Basics, an ANAD affiliation agreement, and a web release form providing the contact information and details for your support group that will be displayed publicly on ANAD's website.
Name *
City and State where your support group will be located *
Personal Phone *
Personal Email *
Occupation (You do not need to be a clinician nor training to be one in order to run an ANAD Support Group)
Date of Birth
If you have not been eating disorder behavior free for 2 years, please put the name and contact information for your group's co-leader below. *
Why do you want to be a Support Group Leader? *
What type of group would you like to lead? (You can select several options.) *
Please give us more information about the type of group you would like to lead if you have a very specific population of people you would like to support.
Have you ever been convicted of a felony or crimes involving sexual misconduct? *
If you answered YES above, please explain below.
Are you bilingual? If so, please list the languages you are fluent in below.
ANAD will be creating regular e-newsletters to send out to Support Group leaders that will highlight stories and experiences from other support group leaders, helpful tips on how to be a successful support group leader, and how to handle potentially challenging situations. Would you like to receive this newsletter? *
Would you like to subscribe to ANAD's general email newsletter? *
How did you hear or find out about ANAD Support Groups? (This helps us out with promoting them!) For example, LinkedIn, Idealist, while reading the ANAD blog, from a therapist or friend, etc. *
If you found out about ANAD through google search, please let us know which terms you were searching for below.
Please type your first and last name in the box below. (By typing your name below, you are verifying that all of the information you have given in this application is correct and true. ) *
Never submit passwords through Google Forms.
This form was created inside of ANAD. Report Abuse